Pharmacy Benefit Manager And Insurer Requirements.
Concerning requirements regarding the administration of prescription drug benefits under health benefit plans. The bill precludes a health insurer, a pharmacy benefit manager (PBM), or an entity acting for a health insurer or PBM to conduct on-site audits of pharmacies within 12 months after a prior on-site audit except in specified circumstances. Additionally, the bill enacts the “Pharmacy Fairness Act” (act), which imposes requirements regarding contracts between PBMs and pharmacies nd prohibits PBMs from:
Restricting a covered person’s access to prescription drug benefits at an in-network retail pharmacy, except as permitted in limited circumstances;
Charging a pharmacy or pharmacist a fee for adjudicating a claim, other than a one-time fee of not more than the lesser of 25% of the pharmacy dispensing fee or 25 cents for receipt and processing of the same pharmacy claim; or
Requiring stricter pharmacy accreditation standards or certification requirements than the standards or requirements that are applicable to similarly situated PBM-affiliated pharmacies within the same PBM network.